应用光学相干断层扫描量化评估糖尿病黄斑水肿的临床研究

目的 探讨糖尿病黄斑水肿患者在光学相干断层扫描(optical coherence tomography,OCT)中四个量化指标的变化.方法 纳入糖尿病视网膜病变患者89例(155眼),按照有无黄斑水肿分为阳性组(33例55眼)及阴性组(56例100眼),另收集正常志愿者23例(42眼)为正常对照组.所有试验对象经OCT检查,测量并分析各组黄斑中心凹视网膜厚度(central retinal thickness,CRT)、黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)的差异,观察各组黄斑区外界膜(external limiting membrane,ELM)、椭圆体带(inner segment/outer segment,IS/OS)的连续性.结果 正常对照组、阴性组、阳性组CRT分别为(219.048±16.798) μm、(217.775±26.866) μm、(280.418±74.187)μm,3组间差异有统计学意义(P ＜0.001);3组SFCT分别为(312.893±140.559) μm、(302.080±125.287) μm、(293.745±140.517) μm,3组间差异无统计学意义(P=0.781);阴性组中黄斑区ELM连续97眼、中断3眼,阳性组连续47眼、中断8眼,两组间ELM连续性差异有统计学意义(P=0.019);阴性组中黄斑区IS/OS连续95眼、中断5眼,阳性组连续36眼、中断19眼,两组间IS/OS连续性差异有统计学意义(P＜0.001).结论 糖尿病黄斑水肿患者CRT增加,黄斑区ELM、IS/OS连续性遭到破坏,CRT、ELM连续性及IS/OS连续性可用于量化评估糖尿病黄斑水肿.     

Patterns of diabetic macular edema with optical coherence tomography

PURPOSE: We report cross-sectional images of diabetic macular edema and correlation between tomographic features and visual acuity with best correction by means of optical coherence tomography. METHOD: In a prospective study, optical coherence tomography was performed in 59 eyes of 42 patients with diabetic macular edema and in 10 eyes of 10 normal control subjects. RESULTS: Optical coherence tomography showed three patterns of structural changes in diabetic macular edema: sponge-like retinal swelling (52 [88%] of 59 eyes), cystoid macular edema (28 [47%] of 59 eyes), and serous retinal detachment (9 [15%] of 59 eyes). Some eyes had more than one pathologic change. Retinal swelling was more pronounced in the outer rather than the inner retinal layers. Cystoid macular edema was located mainly in the outer retinal layers. In eyes with long-standing cystoid macular edema, cystoid spaces had fused, resulting in a large cystoid cavity involving almost the entire retinal layer. Hard exudates were seen as highly reflective areas located in the outer retinal layers. The retinal thickness at the central fovea and the visual acuity with best correction showed an intermediate negative correlation in eyes without cystoid macular edema (correlation coefficient: -0.61, P < .01). CONCLUSIONS: Diabetic macular edema involved three structural changes, including sponge-like retinal swelling (88%), cystoid macular edema (47%), and serous retinal detachment (15%). Visual acuity with best correction moderately correlated with retinal thickness regardless of the different tomographic features.     

Temporal variation in diabetic macular edema measured by optical coherence tomography

PURPOSE: To determine, by optical coherence tomography (OCT), whether there is a quantitative decrease in macular edema in diabetic subjects over the course of a day. STUDY DESIGN: Observational case series. PARTICIPANTS: Ten subjects with diabetic macular edema in 1 or both eyes. METHODS: Subjects were admitted to the hospital the evening before the study so that they would remain in the recumbent position until immediately before study measurements began. They then underwent 4 OCT measurements of macular thickness in both eyes, at 8:00 am, 11:00 am, 2:00 pm, and 5:00 pm. At each of these times, they also had refractions and visual acuity measurements using the Early Treatment Diabetic Retinopathy Study protocol. Macular thickness measurements determined by the Zeiss-Humphrey (Dublin, CA) optical coherence tomograph for each eye of each subject were plotted as a function of time. MAIN OUTCOME MEASURES: Temporal changes in retinal thickness in each of the 9 macular sectors defined by the OCT protocol and in the entire macula of each eye, averaged from all 9 sectors; temporal changes in refractive error and visual acuity. RESULTS: Four of the 10 subjects showed consistent decreases in macular thickness over the course of the day in 1 or more of the retinal sectors in 1 or both eyes. When macular thickness values were averaged over all 9 sectors for all subjects, both eyes showed consistent declines in mean thickness throughout the day. By t test, the 8 am value in each eye was significantly higher (P<0.0005) than any of the 3 later values, which did not differ significantly from each other. However, comparison of all 4 values by analysis of variance showed no significant differences. With the exception of 1 subject, there were no consistent changes in refractive error or in best-corrected visual acuity over the course of the study. CONCLUSIONS: This study, using quantitative OCT determinations, seems to confirm the much earlier report by Sternberg et al, which used more subjective methods, that macular edema might vary over the day. That the 8 am value, obtained just after waking, was higher than the 3 later values (highly significant by 1 test) suggests that the decrease in macular thickness is most likely due to the shift from recumbent to upright body position, although our study protocol did not exclude other possible mechanisms. Although changes in macular thickness over the course of the day did not occur in all subjects, therapeutic studies for macular edema that use OCT as an outcome measure should control for time of day when these measurements are carried out.     

Correlation between optical coherence tomography, multifocal electroretinogram findings and visual acuity in diabetic macular edema

AIM: To compare the effects of yellow (577 nm) subthreshold micropulse laser (SML) and intravitreal (IV) anti-vascular endothelial growth factor (VEGF) treatment in patients with diabetic macular edema (DME) with relatively better visual acuity [best corrected visual acuity (BCVA) ≤0.15 logMAR]. METHODS: The medical records of 76 eyes of 47 patients underwent IV (0.5 mg) anti-VEGF injection or SML for the DME with relatively better BCVA were reviewed. The IV group received three consecutive monthly IV anti-VEGF injections, then were retreated as needed. The laser treatment group was treated at baseline and 3mo, and then retreated at 6 and 9mo if needed. All participants were followed up for one year. The mean BCVA and mean central macular thickness (CMT) values changes over the follow-up were evaluated. RESULTS: Twenty-four and 23 patients were assigned to the SML and IV subgroups, respectively. The mean number of treatments was 3.64±0.76 in SML group and 5.85±1.38 in IV group (P<0.05). The subgroups were similar with regard to the mean BCVA score at baseline and at the 1st and 3rd months, but the score of SML group was better than that of IV group at the 6th, 9th and 12th months (P<0.05). The decrease in the mean CMT values from baseline values was higher in SML group at the 6th, 9th, and 12th months (P<0.05). CONCLUSION: Yellow SML treatment is superior to IV anti-VEGF injection in DME patients with relatively better BCVA for increasing visual acuity and decreasing CMT at 6, 9, and 12mo. SML can be a good alternative first-line therapy for DME with BCVA ≤0.15 logMAR.     

光学相干断层扫描对糖尿病性黄斑水肿的诊断意义

目的:观察黄斑水肿的光相干断层扫描(OCT)图像特征;探讨糖尿病黄斑水肿与视力、糖尿病性视网膜病变分期和糖尿病病程的关系。方法:对58例(97眼)患者通过荧光血管造影分期分组,OCT测量各组厚度后,采用SPSS10.0软件进行统计学分析,分析各型黄斑水肿构成比及其与视力、糖尿病病程、分期的关系。结果:黄斑水肿的OCT图像主要包括视网膜海绵样肿胀、黄斑囊样水肿及神经上皮浆液性脱离;随糖尿病病程延长,糖尿病视网膜病变的发展,黄斑水肿构成比逐渐增加、病变加重,黄斑区视网膜厚度有增加趋势,视功能受损程度加重。结论:糖尿病性视网膜黄斑水肿的OCT图像为临床提供类似病理学的直观资料,尤其对治疗的随诊及判定预后具有重要参考价值。     

糖尿病性黄斑水肿的光学相干断层成像

目的:观察糠尿病性黄斑水肿(diabetic macular edema,DME)的光学相干断层成像(optical coherence tomography,OCT)图像特征,分析其黄斑视网膜厚度与视力的关系.方法:对50例80眼经检眼镜或荧光素眼底血管造影(fundus fluorescein angiography,FFA)检查确诊为糖尿病视网膜病变伴黄斑水肿的患者进行经黄斑中心凹水平和垂直线性扫描的OCT检查.结果:10眼表现为黄斑中心凹局限性水肿改变,21眼表现为黄斑中心凹囊样改变伴神经上皮层浆液性脱离,49眼表现为黄斑区视网膜神经上皮层弥漫性增厚.DME患者黄斑视网膜厚度与视力呈负相关关系(r=-0.60,P=0.000).结论:DME的主要OCT图像特征为黄斑视网膜弥漫性水肿、黄斑囊样水肿伴神经上皮层脱离和黄斑局限性水肿改变;DME患者黄斑水肿越严重,视力越差.     

糖尿病性黄斑水肿的光学断层扫描与多焦视网膜电图的改变

目的探讨糖尿病黄斑水肿的光学相干断层扫描(optical coherence tomcgraphy,OCT)与多焦视网膜电图(multifocal elec-troretinography,MERG)的影响.方法糖尿病黄斑水肿患者39人60只眼,经眼底检查黄斑部视网膜增厚大于1PD、有硬性渗出,荧光造影检查黄斑部有荧光渗漏、OCT检查中心凹厚度大于170um.除外影响黄斑的其他眼底疾病,进行OCT检查中心凹、经中心凹225、315经线的两侧约1000um处视网膜神经上皮层处测量.常规进行MERG检查.18人35只与年龄相配的正常眼对照组以同样方法行OCT及MERG贴检查与糖尿病黄斑水肿眼进行对比分析.结果糖尿病黄斑水肿组中心凹、鼻上、鼻下、颞上、颞下视网膜神经上皮层厚度分别为320.62±188.82um、354.78±120.92um、346.12±120.43um、353.17±100.68um、350.0±114.81um,对照组分别为139.55±5.01um、284.13±15.04um、285.48±16.23um、281.84±15.89um、286.94±14.13um,单因素方差分析中心凹及各象限组间均有极显著性差异(P值均＜0.01),中心1环和4环的N1、P1波潜伏期和振幅密度糖尿病水肿组与对照组之间有极显著性差异,P值均＜0.001.黄斑部的神经上皮层厚度与MERG的N1波、P1波潜伏期及振幅密度的相关性分析中心凹厚度与中心1环P1波潜伏期有正相关r=0.366,P=0.004.回归方程Y=-127.98+15.10X,P=0.005.N1、P1波振幅密度无相关性,r=0.125～-0.088,P＞0.05.环4的神经上皮厚度与N1、P1波潜伏期有显著正相关,r=0.431～0.392,P＜0.001,回归方程Y=-26.86+17.66X-5.99X,P＞0.05.与N1、P1波振幅密度无明显相关性,r=0.036-0.165,P＞0.05.结论糖尿病黄斑水肿的视网膜神经上皮与正常对照组间有显著性差异,神经上皮水肿的厚度主要影响MERG的N1、P1波潜伏期,导致潜伏期明显延长,中心凹的水肿程度与P1波潜伏期呈直线关系.     

糖尿病黄斑水肿中光相干断层扫描生物学标志物研究进展

糖尿病视网膜病变(DR)是糖尿病患者常见的眼部并发症,而糖尿病黄斑水肿(DME)是DR患者视力丧失的主要原因,因此DME的早期诊治有重要临床意义。光相干断层扫描(OCT)检查可实现视网膜和脉络膜各个层次的高质量成像,已广泛应用于临床,可用于DME的诊断和治疗效果的长期随访。近年来研究发现DME在OCT图像上视网膜和脉络...     

OCT和OCTA生物学标志物在糖尿病性黄斑水肿预后和监测中的应用

糖尿病性黄斑水肿(DME)是糖尿病视网膜病变(DR)的并发症,也是DR患者视力下降和失明的主要原因。光学相干断层扫描(OCT)和光学相干断层扫描血管造影(OCTA)作为无创、非侵入性评估视网膜各层微结构和微血管病理改变的主要检查手段,是检测和评估DME的常用方法。随着OCT和OCTA技术的不断发展,各种参数被赋予生物标志物的作用,例如中央凹厚度(CST)、黄斑部平均厚度(CAT)和黄斑部容积(CV)、视网膜内层结构紊乱(DRIL)、高反射灶(HRF)和中央凹下神经视网膜脱落(SND)等,广泛运用于临床。OCT可以直观显示黄斑区视网膜及脉络膜的层次变化和细微结构,而OCTA更常运用于微血管改变。本文就OCT及OCTA相关生物学标志物在DME中预后和监测的作用进行阐述,同时检测结果中可见的生物学标志物可以为DME的监测和治疗策略提供新思路,并为DR和DME的发病机制提供新的见解。     

Volcano like pattern in optical coherence tomography in chronic diabetic macular edema

In this article we herein report an interesting vitreo-macular interface abnormality associated with chronic diabetic cystoid macular edema. It is an observational case study of three diabetic patients examined in the diabetic clinic. All the patients had proliferative diabetic retinopathy with chronic macular edema. A serial cross sectional OCT examination and tracking of both the longitudinal progression of macular thickening and vitreo-macular interface revealed cystoid macular edema with a characteristic hyperreflective vitreous shadow emerging from the vitreofoveal interface. All the patients had dehiscence of inner retinal layers.This particular morphological feature at the vitreo-foveolar interface, which we name as “volcano sign”, has not been described earlier. The probable mechanism of such a finding probably could be due to slow progressive leakage of chronic cytoid fluid into the vitreous with condensation of the overlying vitreous. Vitreo-macular traction followed by posterior vitreous detachment probably would have contributed to such a morphological event.     

OCT在糖尿病性黄斑水肿激光治疗中的应用

目的:探讨光学相干断层扫描(optical coherence tomography,OCT)在糖尿病性黄斑水肿(diabetic macular edema,DME)激光治疗后临床观察中的应用.方法:回顾性病例研究,选取2015-01/2016-06在秦皇岛市海港医院行黄斑区格栅样光凝治疗的DME患者188例376眼,治疗1 mo后利用OCT检测黄斑区6 mm范围内视网膜厚度,采用SPSS19.0统计软件对所得数据进行分析.结果:格栅样光凝1 mo后,患者黄斑中心凹至1mm、黄斑1~3 mm、黄斑3~6 mm平均视网膜神经上皮层厚度分别为332.02±18.07、393.40±19.71、372.00±20.01μm,与治疗前(404.70±16.37、445.17±18.25、410.87±18.14μm)比较,差异具有统计学意义(P<0.05).三者厚度变化分别为72.68±14.74、51.77±9.48、38.87±17.94μm,组间及两两比较,差异具有统计学意义(P<0.05).结论:DME经格栅样光凝治疗1mo后黄斑区视网膜神经上皮层厚度降低,并且越接近黄斑中心凹处,降低作用越明显.     

光学相干断层扫描在糖尿病性黄斑水肿的诊断

目的阐明糖尿病性黄斑水肿的光学相干断层扫描(Optical coherence tomography,OCT)特征.方法对37例61眼糖尿病合并黄斑区水肿患者进行OCT检查及资料分析.结果 (1)黄斑区局限性水肿者OCT图像:①11眼表现为局限性视网膜层间海绵样增厚;②2眼为单纯性小范围神经上皮层浆液性脱离.(2)黄斑区及其周围弥漫性水肿者OCT图像:①12眼表现弥漫性视网膜层间海绵样膨胀增厚;②7眼可见包括中心凹的视网膜层间海绵样膨胀在内的神经上皮层脱离;③29眼表现为黄斑囊样水肿.(3)61跟中发现有22眼伴玻璃体部分后脱离,5眼伴玻璃体完全性后脱离.结论糖尿病性视网膜黄斑水肿的OCT图像为临床提供类似病理学的直观资料,尤其对治疗的随诊及判定预后具有重要参考价值.     

Aflibercept combined with triamcinolone acetonide in the treatment of diabetic macular edema: optical coherence tomography and optical coherence tomography angiography

AIM: To analyze the relationship between optical coherence tomography (OCT) and OCT angiography (OCTA) imaging in patients with diabetic macular edema (DME) who are treated with a combination of aflibercept and triamcinolone acetonide (TA). METHODS: A total of 76 eyes newly diagnosed DME were included in this study. They were randomly assigned to receive either aflibercept or a combination of aflibercept and TA. Injections once a month for a total of three injections. Central macular thickness (CMT), number of hyperreflective foci (HRF), height of subretinal fluid (SRF), and area of foveal avascular zone (FAZ) were evaluated using OCT and OCTA at baseline and after each monthly treatment. RESULTS: Both groups showed improvement in best corrected visual acuity (BCVA) and reduction in macular edema after treatment, and the difference in BCVA between the two groups was statistically significant after each treatment (P<0.05). The difference in CMT between the two groups was statistically significant after the first two injections (P<0.01), but not after the third injection (P=0.875). The number of HRF (1mo: 7.41±8.25 vs 10.86±7.22, P=0.027; 2mo: 5.33±6.13 vs 9.12±8.61, P=0.034; 3mo: 3.58±3.00 vs 6.37±5.97, P=0.007) and height of SRF (1mo: 82.39±39.12 vs 105.77±42.26 μm, P=0.011; 2mo: 36.84±10.02 vs 83.59±37.78 μm, P<0.01; 3mo: 11.57±3.29 vs 45.43±12.60 μm, P<0.01) in combined group were statistically significant less than aflibercept group after each injection, while the area of FAZ showed no significant change before and after treatment in both groups. CONCLUSION: The combination therapy of aflibercept and TA shows more significant effects on DME eyes with decreased HRF and SRF. However, both aflibercept and combination therapy show no significant change in the area of FAZ.     

Assessment of serous macular detachment in eyes with diabetic macular edema by use of spectral-domain optical coherence tomography

Background

The introduction of optical coherence tomography (OCT) has brought new potentialities for an objective evaluation of macular diseases. The purpose of the present study was to assess the serous macular detachment (SMD) in eyes with diabetic macular edema (DME) by use of spectral-domain OCT.

Methods

In this prospective study were included 79 eyes of 46 patients with diabetic retinopathy and DME. All patients underwent examination of best-corrected visual acuity (BCVA), non-contact slit-lamp fundus biomicroscopy, fluorescein angiography and OCT. Spectral-domain OCT (OCT/SLO Combination Imaging System, OPKO/OT Inc., Toronto, Ontario, Canada) was used to evaluate retinal morphology and the presence of macular traction (vitreomacular and/or from epiretinal membranes) on B-scans, C-scans and C-scan OCT/SLO fundus image overlays. With OCT were measured retinal thickness, volume, diameter of intraretinal cystoid spaces, diameter and height of SMD. The correlation of retinal thickness and volume with BCVA in all eyes with DME and the relation of SMD to retinal thickness, volume, BCVA, macular traction and ischemia were assessed.

Results

The SMD was diagnosed only by means of OCT in nine eyes (11.4%) of five patients. In eight of nine eyes it was combined with intermediate (300–600 µm) or severe (>600 µm) cystoid spaces, and in one eye with simple macular edema. Retinal thickness and volume correlated with BCVA (r?=?0.464, P?<?0.0001 and r?=?0.480, P?<?0.0001). The SMD height did not correlate with retinal thickness, volume or BCVA. Six eyes with SMD had macular ischemia, and five eyes had severe ischemia in retinal periphery. Macular traction was: absent in three eyes, questionable (without distortion of retinal contour from partial posterior vitreous detachment and/or epiretinal membrane) in three eyes, and definite (with distortion of retinal contour) in three eyes.

Conclusions

Spectral-domain OCT provided valuable information on retinal morphology and was particularly useful in diagnosing sub-clinical SMD in eyes with DME. It disclosed the presence and strength of macular traction either by partially detached posterior hyaloid or by epiretinal membranes. C-scans and C-scan OCT/SLO fundus image overlays added complementary information for the extent and location of the pathological features. Larger studies which follow subjects longitudinally are needed to explain the pathogenesis and determine the prognosis of SMD.     

Sensitivity and specificity of time-domain versus spectral-domain optical coherence tomography in diabetic macular edema

Purpose:

The purpose was to evaluate the sensitivity and specificity of measurements of central macular thickness (CMT) in diabetic macular edema using stratus time-domain and cirrus spectral-domain optical coherence tomography (OCT; Carl Zeiss Meditec, Dublin, CA).

Materials and Methods:

A total of 36 eyes from 19 patients with clinically significant diabetic macular edema (DME) were included. All participants underwent automated scanning patterns using cirrus HD-OCT and stratus OCT examinations on the same day. The sensitivity/specificity of retinal thickness measurements was calculated from published normative data. Agreement was calculated using Bland--Altman method. The receiver operating characteristic curves (ROC) and areas under the ROC were plotted.

Results:

The mean difference between the cirrus HD-OCT and stratus OCT in the central foveal zone was 49.89 μm. Bland--Altman analysis confirmed that the retinal thickness measurements had poor agreement in patients with DME. The areas under the ROC for retinal thickness measurements were 0.88 using cirrus HD-OCT and 0.94 with stratus.

Conclusions:

In patients with DME, the cirrus HD-OCT gives a higher reading than stratus OCT with poor agreement between the devices in most regions within the nine subfield zones. The sensitivity and specificity of the stratus OCT was comparable to the cirrus.